Pharmacy bodies have called for treatment guidelines for generalised anxiety disorder and panic disorders in adults to be reviewed following “patient safety concerns” relating to propranolol.
In a joint letter sent last month, the General Pharmaceutical Council (GPhC), Royal College of Pharmacy (RCPharm), College of Mental Health Pharmacy (CMHP) and Patient Safety Commissioner for England told the National Institute for Health and Care Excellence (NICE) that propranolol continues to be “implicated in several deaths”.
Read more: RCPharm calls for review of propranolol safety information
The GPhC-coordinated letter said “multiple fatal overdoses” linked to propranolol had been highlighted in recent prevention of future death (PFD) reports, despite the British National Formulary containing safety warnings for the drug.
The bodies asked for NICE to update its clinical guideline to “clearly state that propranolol is not recommended by NICE” for managing anxiety disorders and to “highlight the risk in overdose”.
NICE’s current guideline for the management of generalised anxiety disorder and panic disorder in adults does not recommend or mention propranolol.
Read more: ‘Highly toxic’: Coroner warns GPs of propranolol overdose risk
NICE last reviewed the guideline in 2025, in response to a coroner’s request in a PFD report, but said it did not update it because propranolol is “used very widely, with millions of items prescribed and used safely each year”.
It also said it did not update the guideline because the Medicines & Healthcare products Regulatory Agency (MHRA) had concerns about “inadvertently raising the profile of propranolol overdose”.
“Significant harm”
The letter to NICE said propranolol is commonly prescribed for anxiety disorders “despite limited evidence supporting efficacy” and the “potential for significant harm”, adding that it carries “a higher risk of convulsions in addition to cardiovascular collapse” than other beta blockers.
The letter highlighted a recent coroner’s report that said propranolol is “highly toxic” and has “no specific antidote” in the event of an overdose.
And it pointed out that the MHRA is currently reviewing “whether stronger safety warnings are needed” for propranolol.
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The letter also called for “further clarification” to support safe and evidence-based practice, noting that clinicians are using “pharmacological options not addressed” in NICE’s treatment guideline.
It added that where propranolol is prescribed by a clinician, the guideline should offer advice on relevant safeguards and prescribing considerations, including “suicide and self-harm risk” and the implementation of measures to “minimise the potential for serious harm”.
“We believe that the addition of clear, specific guidance would help reduce avoidable harm, and support clinicians in delivering consistent, evidence-based care,” the letter concluded.
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It comes after the RCPharm called for a review of propranolol safety information last month, and wrote to the MHRA to request updates to the beta blocker’s summary of product characteristics.
And it follows a coroner in April warning GPs of the risk of propranolol overdose following the death of a man who took a “significant amount” of the drug.
